Chemotherapy and targeted therapies for meningiomas: what is the evidence?. Issue 6 (8th December 2021)

• Record Type: Journal Article
• Authors: Graillon, Thomas; Tabouret, Emeline; Chinot, Olivier
• Is Part Of: Current opinion in neurology. Volume 34:Issue 6(2021)
• Page Start: 857
• Page End: 867
• Publication Date: 2021-12-08
• Subjects: immunotherapy -- meningioma -- mTOR -- targeted therapy -- VEGF; Neurology -- Periodicals; Nervous system -- Diseases -- Periodicals; 616.805
• DOI: 10.1097/WCO.0000000000001002
• Languages: English
• ISSNs: 1473-6551

Abstract

Abstract : Purpose of review: Although most meningiomas are slow growing tumors mainly controlled by surgery with or without radiotherapy, aggressive meningiomas that fail these conventional treatments constitute a rare situation, a therapeutic challenge and an unmet need in neuro-oncology. Recent finding: Mutational landscape in recurrent high-grade meningiomas includes mainly NF2 mutation or 22q chromosomal deletion, whereas telomerase reverse transcriptase promoter, BAP-1 and CDK2NA mutations were also found in aggressive meningiomas. Pi3K-Akt-mTOR pathway is currently the most relevant intracellular signaling pathway target in meningiomas with preliminary clinical activity observed. Assessment of drug activity with progression free survival rate at 6 months is challenging in regard to meningioma growth rate heterogeneity, so that 3-dimensional growth rate before and during treatment could be considered in the future to selected new active drugs. Summary: Despite a low evidence level, some systemic therapies may be considered for patients with recurrent meningioma not amenable to further surgery or radiotherapy. In recurrent high-grade meningioma, everolimus-octreotide combination, bevacizumab, sunitinib and peptide receptor radionuclide therapy exhibit a signal of activity that may justify their clinical use. Despite a lack of clear signal of activity to date, immunotherapy may offer new perspectives in the treatment of these refractory tumors.